Provider Demographics
NPI:1912971417
Name:FERGUSON, DENNIS BURKE (PHD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:BURKE
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16337
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-2337
Mailing Address - Country:US
Mailing Address - Phone:405-858-7773
Mailing Address - Fax:405-858-7774
Practice Address - Street 1:1608 NW EXPRESSWAY ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1402
Practice Address - Country:US
Practice Address - Phone:405-858-7773
Practice Address - Fax:405-858-7774
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK797103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist